The present method and apparatus for rotator cuff repair generally relates to methods and devices for surgical repair of soft tissue damage. More specifically, the present method and apparatus-for rotator cuff repair relates to methods and devices for reattaching tendons to bone.
It has been estimated that over 15 million people in the United States alone are at risk from disability related to rotator cuff injuries. The rotator cuff is a group of four muscles in the shoulder: the supraspinatus; the infraspinatus; the teres minor; and the subscapularis. The supraspinatus extends over the top of the humerus, and is attached to the top of the humeral head by a tendon. This tendon can tear, and often tears away from the humeral head. These tears cause pain and limited mobility. Surgical repair of rotator cuff tears is common, but the surgical technique used to accomplish these repairs has changed significantly over time.
Historically, rotator cuff repairs have been performed in an open fashion. The traditional open approach involved a relatively large incision, e.g. 5 cm, and splitting of the deltoid to “open” the affected area for repair. Once open, the humeral head was exposed, and a burr and rongeur were typically used to create a trough in the top of the humeral head, exposing bone marrow on all sides and the bottom of the trough. A transosseous bone tunnel or tunnels were also created between the trough and the lateral cortex. The tendon was sutured, and the sutures passed through transosseous tunnel(s). The tendon was then pulled into the trough, and the sutures were typically tied over the lateral cortex for fixation.
The open approach is still described as the “gold standard” of rotator cuff repair because of the excellent functional results that rarely deteriorate over time. The trough provides excellent biological fixation between the tendon and the bone. Yet, a major disadvantage of the open technique is the required traumatic splitting of the deltoid. This often causes a long recovery time for patients, and can result in deltoid dehiscence and deltoid atrophy.
Over time, rotator cuff repair has evolved to include less invasive and traumatic approaches. A “mini-open” approach was developed that still involved an open incision and splitting of the deltoid to fix the tendon to the humeral head, but took an arthroscopic approach to other aspects of the repair. For example, in the mini-open approach, an arthroscope can be used to inspect the tear and surrounding anatomy. The tendon can also be released arthroscopically, and a subacromial bursectomy and decortication of the greater tuberosity performed. The tendon is typically fixed, however, using anchors or transosseous tunnels through a traditional open incision. Decortication of the humeral head is intended to promote a biological healing response, but is inferior to the creation of a trough.
Most recently, various techniques for purely arthroscopic rotator cuff repair have been developed. In these approaches, tendon fixation is also accomplished arthroscopically. These purely arthroscopic approaches rely on suture anchors implanted arthoscopically into the humeral head for fixation of the tendon. One disadvantage of the purely arthroscopic approaches is the technical complexity of such an operation. The most significant disadvantage of this approach, however, is that it lacks the biological healing associated with the tendon-to-trough healing of the open repair. Today's arthroscopic repair failures are commonly associated with bone, anchor, suture, or suture to tendon failure. Numerous refinements in suture techniques and anchor designs have been made in response, yet these refinements do not promote biological healing that may be crucial to obtaining lasting rotator cuff repairs.